Psychopathic tendencies are selectively associated with reduced emotional awareness in the context of early adversity

It is unclear at present whether psychopathic tendencies are associated with lower or higher levels of emotional awareness (EA). Given that psychopathy includes a proficiency for manipulating others, one might expect an elevated ability to identify and use information about others’ emotions. On the other hand, empathic deficits in psychopathy could arise from reduced emotional awareness. Further, heterogeneity in psychopathy may also play a role, wherein ‘secondary’ psychopathy is associated with early adversity and high negative affect, while ‘primary’ psychopathy is not. In this paper, we tested the relationship between EA and psychopathic tendencies in 177 undergraduate students (40 males) who completed the levels of emotional awareness scale (LEAS), the triarchic psychopathy measure (TPM), the affective (empathy-related) subscales of the interpersonal reactivity index (IRI), and two measures of early adversity: the childhood experiences of care and abuse questionnaire (CECA) and the childhood trauma questionnaire (CTQ). We found that lower LEAS scores were associated with higher TPM and lower IRI empathy scores, but these relationships were primarily present in those with early adversity and high negative affect. This suggests that lower EA may be selectively associated with higher levels of secondary psychopathy, while those with higher levels of primary psychopathy remain capable of higher EA.

To better understand the relationship between these measures, we subsequently conducted post-hoc correlations with CECA subscales (shown in Fig 3 in the main text). These revealed that the negative relationship between IRI Empathic Concern and CECA Total scores was driven primarily by Mother Neglect scores. The 2nd-best model removed the interaction (BF = .44 relative to the winning model).

Subsequent analyses showed a nonsignificant relationship between CTQ Total scores and IRI
Empathic Concern scores (r = -.13, p = .09, BF = .71). The interaction between LEAS and CTQ scores was driven by a stronger positive relationship between LEAS scores and IRI Empathic Concern scores in those with higher CTQ scores. This interaction was less apparent when taking the same median split on CTQ scores as in our previous analyses (See Fig 2 in the main text).
Post-hoc correlations (Fig 3 in the main text) revealed that the positive relationship with LEAS Total scores was also present in both Self and Other subscales, and that there was a negative relationship between IRI Empathic Concern and CTQ physical abuse scores.

IRI Personal Distress Analyses
In a Bayesian regression analysis assessing age, sex, CECA Total scores and LEAS Total scores 12, BF = 0.27). An analogous two-sample t-test revealed that high-TPM/high-CTQ individuals showed significantly greater personal distress than high-TPM/low-CTQ individuals (t(82) = 3.03, 95% CI [0.95, 4.6], p = .003, d = .69, BF = 11.12). The BF for the CTQ analysis provides strong evidence for the presence of this difference, but the BF for the CECA analysis provides poor evidence. This suggests there may be distinct subpopulations of high-psychopathy individuals that do or do not have a disposition to experience strong distress.

Low Empathy Analyses
As with analyses of high-psychopathy individuals in the main text, to selectively examine lowempathy participants we here performed a median split on IRI Empathic Concern scores (low < 22, high ≥ 22) and then restricted analyses to low-empathy participants. We then used the same Bayes factor model comparison approach as in our primary analyses. This allowed us to test for evidence of heterogeneity in EA within low-empathy individuals in relation to early adversity (i.e., consistent with primary vs. secondary psychopathy). Remaining high-empathy individuals were not the focus of these analyses (12/40 males, 79/133 females).
Using the CECA, the most evidence was found for a model including sex  Post-hoc comparisons of other outcome measures between low-empathy/high-early adversity and low-empathy/low-early adversity individuals are shown in Table S1. Notably, unlike Meanness and Disinhibition, TPM Boldness was higher in those with Low CECA/CTQ scores; PANAS Positive Affect was higher in those with low CECA scores; Empathic Concern was higher in those with low CECA scores; and LEAS Self scores were higher in those with low CECA/CTQ scores. Although not shown in Table S1 [1]. b p-values are based on two-sample t-tests between those with high vs. low CTQ or CECA scores (based on median splits). c Note that, after quality control checks, the final N regarding high vs. low CECA analyses changed for the PANAS (N = 90).

Proportion of Individuals with High Psychopathy and High Emotional Awareness
To assess the proportion of individuals with high psychopathy and high emotional awareness, we took a median split on LEAS Total scores and a median split on TPM Total scores across the sample. Combining these median splits showed that there were 41 individuals (23.3% of the full sample) with scores greater than or equal to the median score for both LEAS Total scores and TPM Total scores (9/40 male, 32/136 female). This indicated that 46.6% of individuals with psychopathic traits also had high EA, and that 42.5% of individuals with high EA also had psychopathic traits.

Proportion of Individuals with Low Empathy and High Emotional Awareness
To assess the proportion of individuals with low empathy and high emotional awareness, we also took a median split on LEAS Total scores and a median split on IRI Empathic Concern scores across the sample. Combining these median splits showed that there were 41 individuals (23.2% of the full sample) with scores greater than or equal to the median score for LEAS Total scores and lower than the median for IRI Empathic Concern scores (10/40 male, 31/136 female). This indicated that 50% of individuals with low empathy also had high EA, and that 42.3% of individuals with high EA also had low empathy.  Fig 2 in the main text, high and low early adversity levels were taken only from individuals with scores above and below the median for the TPM and IRI, respectively. The blue lines illustrate the correlations in the remaining low psychopathy and high-empathy individuals. As can be seen, the pattern of results was similar in males and females.